Form cover
Page 1 of 1

Steve’s Coaching Intake Form

I appreciate you taking the time to fill out this form! 👌🏻
Thank you! 🙏🏻

This form helps me understand who you are, what your goals are, your health, how your lifestyle affects you and your history with training.


Your information is confidential and used only for coaching and program design.

Section 1: Your Details

First & Last Name

Date of Birth

Phone Number

Email Address

Mailing Address

Section 2: Your Goals

What is your top 3 fitness or health goals?

What is your top 3 fitness or health goals?
A
B
C
D
E
F
G

Other Goals: share details below

What motivated you to start working on these goals now?

How committed are you to achieving these goals?

How committed are you to achieving these goals?

What has stopped you from reaching your goals before?

What has stopped you from reaching your goals before?
A
B
C
D
E
F
G
H

In 3-6 months, what would "success" look like to you?

Section 3: Your Training Background

Where do you primarily workout?

Where do you primarily workout?
A
B
C
D
E

What types of workouts have you done before?

What did you like or dislike about past training?

What are you currently doing for exercise?

What are you currently doing for exercise?
A
B
C
D
E
F

How often do you exercise?

What equipment do you have access to for working out?

Section 4: Your Nutrition & Lifestyle

Do you currently track your nutrition or follow a specific approach?

Do you currently track your nutrition or follow a specific approach?
A
B
C
D
E
F

How many meals do you usually eat per day?

How many meals do you usually eat per day?
A
B
C
D

Which best describes your current eating habits?

Do you have any food allergies, intolerances, or strong preferences?

Do you have any food allergies, intolerances, or strong preferences?
A
B
C
D
E

If comfortable sharing, what's a typical day of eating like? (Optional)

Lifestyle

How would you describe your daily activity level outside of the gym?

How would you describe your daily activity level outside of the gym?
A
B
C

How many hours of sleep do usually get per night?

How many hours of sleep do usually get per night?
A
B
C
D

How would you rate your current level of stress?

How would you rate your current level of stress?
A
B
C

Section 5: Your Commitment & Readiness

Which best describes your mindset right now? (select one)

Which best describes your mindset right now? (select one)
A
B
C
D
E

What are you willing to work on to reach your goals? (select all that apply)

What are you willing to work on to reach your goals? (select all that apply)

What are you NOT willing to do to achieve your goals?

Section 6: Coaching Options & Discovery

Which services are you interested in? (Select all that apply)

What are you looking for in a coach?

How did you hear about us?

Section 7: Health History, Coaching & Consent

Health History

What medical conditions or injuries have you been diagnosed with (past or present)?

Do you have any health concerns, pain or injuries that may affect training?

Are you currently taking any medications (prescription or over-the-counter)?

Are you currently taking any medications (prescription or over-the-counter)?
A
B

If yes please list below

How would you rank your health right now?

How would you rank your health right now?

Health & Liability Disclaimer

Your safety is a priority.

By submitting this form, you acknowledge that:
Participation in exercise and training involves inherent risk.
You are responsible for consulting a qualified healthcare provider before beginning any new fitness or nutrition program.

You voluntarily assume full responsibility for your health and participation in all training activities.

Client Agreement:

Untitled checkboxes field

Client Signature

Signature